A social systems analysis of implementation of El Salvador's national HIV combination prevention: a research agenda for evaluating Global Health Initiatives. BMC Health Serv Res 2018 Nov 12;18(1):848
Date
11/14/2018Pubmed ID
30419904Pubmed Central ID
PMC6233270DOI
10.1186/s12913-018-3667-8Scopus ID
2-s2.0-85056355207 (requires institutional sign-in at Scopus site) 5 CitationsAbstract
BACKGROUND: Global Health Initiatives (GHIs) have been instrumental in the rapid acceleration of HIV prevention, treatment access, and availability of care and support services for people living with HIV (PLH) in low and middle income countries (LMIC). These efforts have increasingly used combination prevention approaches that include biomedical, behavioral, social and structural interventions to reduce HIV incidence. However, little research has evaluated their implementation. We report results of qualitative research to examine the implementation of a national HIV combination prevention strategy in El Salvador funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria.
METHODS: We conducted in-depth interviews with principal recipients of the funding, members of the Country Coordinating Mechanism (CCM) and front line peer outreach workers and their clients. We analyzed the data using a dynamic systems framework.
RESULTS: El Salvador's national HIV combination prevention strategy had three main goals: 1) to decrease the sexual risk behaviors of men who have sex with men (MSM), commercial sex workers (CSW) and transgender women (TW); 2) to increase HIV testing rates among members of these populations and the proportion of PLH who know their status; and 3) to improve linkage to HIV treatment and adherence to antiretroviral therapy (ART). Intervention components to achieve these goals included peer outreach, community prevention centers and specialized STI/HIV clinics, and new adherence and retention protocols for PLH. In each intervention component, we identified several factors which reinforced or diminished intervention efforts. Factors that negatively affected all intervention activities were an increase in violence in El Salvador during implementation of the strategy, resistance to decentralization, and budget constraints. Factors that affected peer outreach and sexual risk reduction were the human resource capacity of grassroots organizations and conflicts of the national HIV strategy with other organizational missions.
CONCLUSIONS: Overall, the national strategy improved access to HIV prevention and care through efforts to improve capacity building of grass roots organizations, reduced stigma, and improved coordination among organizations. However, failure to respond to environmental and organizational factors limited the intervention's potential impact.
Author List
Dickson-Gomez J, Glasman LA, Bodnar G, Murphy MAuthors
Julia Dickson-Gomez PhD Professor in the Institute for Health and Equity department at Medical College of WisconsinLaura R. Glasman PhD Associate Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultEl Salvador
Female
Global Health
HIV Infections
Health Promotion
Health Services Accessibility
Homosexuality, Male
Humans
Incidence
Malaria
Male
Mass Screening
Program Evaluation
Qualitative Research
Risk Reduction Behavior
Risk-Taking
Sex Work
Sex Workers
Sexual Behavior
Sexual and Gender Minorities
Social Stigma
Systems Analysis
Transsexualism
Tuberculosis
Unsafe Sex
